Provider Demographics
NPI:1437768728
Name:NEZARIA, MARISA J (NP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:J
Last Name:NEZARIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:88 MONTVALE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3644
Mailing Address - Country:US
Mailing Address - Phone:781-481-9255
Mailing Address - Fax:781-481-9257
Practice Address - Street 1:88 MONTVALE AVE STE 3
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3644
Practice Address - Country:US
Practice Address - Phone:781-481-9255
Practice Address - Fax:781-481-9257
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2328815163W00000X, 363L00000X
MARN2328815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner